- vertex presentation or face presentation with chin-anterior or entrapped after-coming head in
- cervix fully dilated;
- head at +2 or +3 station or 0/5 palpable.
At a minimum, the sagittal suture should be in the midline and straight, guaranteeing an occiput anterior or occiput posterior position.
Provide emotional support and encouragement. If necessary,
use a pudendal block.
Assemble the forceps before application. Ensure that the parts fit together and lock well.
Lubricate the blades of the forceps.
Wearing high-level disinfected gloves, insert two fingers of the right hand into the vagina on the side of the fetal head. Slide the left blade gently between the head and fingers to
rest on the side of the head (Fig P-10).
A biparietal, bimalar application is the only safe application.
Applying the left blade of the forceps
Applying the right blade of the forceps
Depress the handles and lock the forceps.
Difficulty in locking usually indicates that the application is incorrect. In this case, remove the blades and recheck the position of the head. Reapply only if rotation is confirmed.
After locking, apply steady traction inferiorly and posteriorly with each contraction (Fig P-12).
Locking and applying traction
- fetal heart rate;
- application of forceps.
When the head crowns, make an adequate
Lift the head slowly out of the vagina between contractions.
The head should descend with each pull. Only two or three pulls should be necessary.
- fetal head does not advance with each pull;
- fetus is undelivered after three pulls with no descent or after 30 minutes.
• Every application should be considered a trial of forceps. Do not persist if there is no descent with every pull.
forceps delivery fails, perform a caesarean section.
Symphysiotomy is not an option with failed forceps.
Injury to facial nerves requires observation. This injury is usually self-limiting.
Lacerations of the face and scalp may occur. Clean and examine lacerations to determine if sutures are necessary.
Fractures of the face and skull require observation.
Uterine rupture may occur and requires immediate treatment.
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